Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor
In Reply: I agree with Mr Jost that Medicare
uses fraud and abuse enforcement to achieve what private insurers accomplish
through active cost management. Each approach has advantages and disadvantages.
Jost applauds the government's antifraud efforts, while I worry that the political
seductiveness of blaming fraud for Medicare's failings distracts us from more
fundamental reforms. I am also not as confident about HCFA's success. Historically,
Medicare costs seesaw with those of employer-based coverage, with cross-subsidies
usually running from private sector to public sector but sometimes reversing
(as when Medicare was overpaying health maintenance organizations who enrolled
healthier-than-average beneficiaries). One can attribute the bulk of Medicare's
current comparative advantage neither to the Balanced Budget Act's1 overcorrection of previously generous reimbursement
nor to aggressive fraud enforcement but to the fortuitous and lamentable fact
that Medicare does not cover outpatient prescription drugs, which have overtaken
hospitalization as the largest item of expense for many private insurers.
Sage WM. Fairness in Fraud and Abuse Enforcement—Reply. JAMA. 2000;283(10):1289-1290. doi:10.1001/jama.283.10.1287